Association Between E-cigarette Use and Asthma Exacerbations Using Nationally Representative Survey Data

Introduction Despite limited knowledge of its potential health effects, electronic cigarette (e-cigarette) use has become increasingly popular in the United States (US). Cigarette smoking is linked to a higher risk of asthma, and e-cigarettes may have similar effects. This study's aim was to examine the association between e-cigarette use and asthma exacerbations in US adults with known asthma. Methods The 2018 Asthma Call Back Survey (ACBS), paired with corresponding data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), was utilized for this analysis. Individuals were divided into the following categories: exclusive e-cigarette users, exclusive cigarette users, dual e-cigarette and cigarette users, and never users. A multivariable logistic regression model utilizing a complex survey design was completed after applying weights for population representation and adjusting for potential confounders. Results Of the 11,598 adults in the study, 453 (3.9%) were exclusive e-cigarette users, 3,735 (32.2%) were exclusive cigarette users, 1,484 (12.8%) were dual users, and 5,926 (51.1%) were never users. There was no statistically significant association between asthma exacerbations and exclusive e-cigarette use (OR: 0.88; 95% CI: 0.56-1.38), exclusive cigarette use (OR: 0.80; 95% CI: 0.60-1.05), or dual-use (OR: 0.98; 95% CI: 0.68-1.41). Conclusion There was no association among the categories of exclusive e-cigarette users, exclusive cigarette users, and dual users with asthma exacerbations among adults 18+ with asthma. The results emphasize a need to continue e-cigarette use research to assess future health effects and formulate appropriate public health recommendations.